Trauma & mass-casualty incidents.

The modern trauma primary survey

Most EMS systems have moved from the classic ABC to MARCH or XABCDE. The reason is simple: a patient can bleed to death in minutes while you fuss with an airway. Stop massive hemorrhage first, then protect the airway, then fix breathing and circulation.

• Massive hemorrhage — tourniquets and direct pressure
• Airway — open, suction, adjuncts
• Respiration — seal sucking chest wounds, needle decompression
• Circulation — IV access, permissive hypotension
• Hypothermia / Head injury — prevent the lethal triad

Mass-casualty triage: START and JumpSTART

During an MCI, your goal shifts from the best care for one patient to the greatest good for the greatest number. Triage tags sort patients by survivability and resource needs. Read the full MCI guide.

Trauma topics at a glance

• Hemorrhage Control

  Tourniquets, direct pressure, hemostatic gauze, and junctional bleeding control.

• Tension Pneumothorax

  Recognition, needle decompression, and the tension-physiology exam.

• Spinal Motion Restriction

  Modern selective SMR criteria and why long boards are extrication tools.

• MCI & Incident Command

  ICS structure, START/JumpSTART triage, and the first 60 seconds.

• Trauma Assessment & Shock

  Primary survey, DCAP-BTLS, and shock recognition.

• Mass Casualty & Triage

  START triage tags, transport priorities, and MCI organization.

Common NREMT trauma traps

• Don't skip scene safety / BSI. The exam will hand you unsafe scenes and expect you to stage first.
• Don't over-resuscitate. In hemorrhagic shock, small fluid boluses and permissive hypotension beat aggressive crystalloid.
• Don't forget hypothermia. Exposure plus resuscitation fluids drops body temp quickly; cover the patient.
• Don't delay tourniquets. If direct pressure won't control extremity bleeding, apply the tourniquet high and tight.
• Don't hyperventilate head injury. Target ETCO₂ 35–40 unless there are signs of herniation.

FAQ